AMCFinancialFormV9 .pdf

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Original filename: AMCFinancialFormV9.pdf
Title: AMCFinancialFormV9
Author: Ner Shalom

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!

!
!
Congregation!Ner!Shalom!201742018!Annual!Membership!Commitment!
!

Annual!Financial!Commitment!Form!201742018!
!
Name(s):!!
Current!Email!Address:!
Preferred!Telephone!number:!
!
PLEDGE!
!
We!(I)!commit!to!an!annual!financial!contribution!for!201672017!of!$!_______!!as!follows:!
!
__!Monthly!payments!of!!
$__________!beginning!on!______________!!
__!Quarterly!payments!of!!
$__________!in!July,!Oct,!Jan!&!April!!
__!One!annual!payment!of!!
$!_________!on!______________!
!
Amount!enclosed!at!this!time:!!$!__________!
!
Amount!donated!on4line:!!
$!__________!
!
PAYMENT!METHOD!
!
Check:!!!!
Mail!to!85!La!Plaza!Cotati,!CA!94931,!!
Bill!pay:!!
Arrange!for!a!monthly!bill!pay!through!your!bank!or!credit!union!
Online!!!
Go!to!http://www.nershalom.org!and!click!on!the!“donate!now”!button!in!the!top!
right!corner)!!
!
Credit!card:! VISA_____!!MasterCard_____!!!American!Express_____!
!
!
Card!number:!_________________________! Exp.!Date:!_____!
CVV!code:!_____!(3!or!47digit!code).!!
!
Please!add!the!5%!service!charge!when!processing!payments:!!Yes___No___!
!
BILLING!METHOD!
!
Please!let!us!know!which!of!the!following!you'd!prefer:!
!
__!
Please!send!my!statement/invoice!via!email!
__!
I'll!pay!without!any!nudging!(but!you!can!get!in!touch!at!the!following!e7mail!if!I!forget)!
__!
Please!automatically!charge!my!credit!card!and!notify!me!via!e7mail!when!my!payment!is!
processed:!
!
!
Congregation!Ner!Shalom!is!a!501!(c)!3!non7profit.!Your!donation!is!tax7deductible.!!!


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